Mourning in Medical School

I climbed into bed on October 11 excited: for the first time in years, I could pinpoint what I was feeling — I was happy. Pure, simple happiness, something that had eluded me for years in the throes of depression and anxiety as a teenager, was a feeling I could recognize again. Wow, I thought, maybe this will be my year. I sent my last email at 10:29 p.m. and curled up in my blankets after saying goodnight to my younger sister and calling my brand new fiance to report how I felt. A little more than an hour later, my wrist was vibrating. I looked down at my Fitbit and saw my sister was calling. This has to be a mistake, I thought, and I pulled the comforter over my head and closed my eyes. No more than a minute later, my phone lit up the room: she was calling again.

“Ammu,” she said, her voice shaking, “Thatha died.” The pit of my stomach free fell, and I exclaimed, “You can’t be serious. He was fine just yesterday.” “No Ammu, he’s gone,” she said, and she started to cry. Stunned, I told her I would call her right back. I frantically dialed our home phone, “Dad, is she telling the truth?” I cried. “Ammu, yes. I’m sorry,” my dad said with the kindest voice. And after that, I hung up the phone and began screaming. My maternal grandfather had suddenly passed away after mounting what seemed to be an unbelievable recovery from a year of neurologic and nephrological illness. Within an hour, everyone was mobilized. My fiance would be in Philadelphia in a few hours and would drive my sister and I home once she arrived from Baltimore. My friends would talk to student affairs and make sure they knew I wouldn’t be coming to school for a few days. I emailed my doctors to reschedule appointments. And then I lay in my bed emotionally paralyzed for hours, clutching to a family portrait and rocking back and forth.

1998 — At home with my maternal grandparents

2015 — My siblings, my cousins and our beloved grandparents

Six hours later, my fiance drove me to 30th St. Station. I repeated to myself a thousand times that I would hold myself together for my sister. I would be strong. I wouldn’t cry. But the second I saw her, I dissolved into tears and started screaming again. The whole drive home I replayed the last day in my head. Twenty-four hours before, I had been awake reviewing obstetrics for the upcoming exam and rushing to get ready for my engagement brunch. My biggest concern was whether I would master the pharmacology of tocolytics in time to straighten my hair. What a difference a day makes — I couldn’t decide if I should continue on in medical school, or consider withdrawing for a trimester to go be with my extended family in India. Okay Ammu, be strong, I told myself as we pulled into the driveway, your family needs you now. We walked in the front door, and for the first ten minutes, I was composed. I helped my sister argue her case so that she could leave for India with my mom that night. My grandmother asked us to come on Skype, and as soon as I saw her, I felt shattered.

I was tasked with making the formal announcement of my Thatha’s passing on Facebook so that relatives all around the world could receive the news while we got around to making flight arrangements for my sister. My paternal aunt drove in from Poughkeepsie to keep us company and to make sure my mom and sister could get to the airport. She made me countless cups of tea while I tried to listen to a lecture on breast cancer while contemplating going to India. “Well, if I withdraw now, I’ll probably have to repeat the whole year,” I said, “but at least I’ll get to mourn.” And then my dad pointed out the pride my Thatha had seeing me in my white coat this summer, and how he wouldn’t want me to take a pause in my studies on his account. I would be in India in a month after all for my formal engagement ceremony. While it weighed heavy on my heart to not go, I knew that staying behind to try to finish the trimester on time is what my Thatha would have wanted. So that evening, I said goodbye to my mother and my sister. My fiance and one of my closest childhood friends helped me pack my bags and head back to school far earlier than I had anticipated.

Every night that week, friends rotated in and out of my apartment to keep me company, give me a hug and make sure I was studying. I did, after all, have an exam that Friday. At night, I was terrified to sleep, jolted by the memory of the despair in my sister’s voice. What could I have done to make this end differently? I kept replaying the night in my head and went to school exhausted every morning. By early afternoon, I felt myself nodding off to sleep, but couldn’t rest unless someone was sitting there watching me. One of my friends graciously switched time slots for a standardized patient with me so I could take the time to rest. Student affairs offered to allow me to delay the exam so I could take more time with my family, but ultimately I decided that I just wanted to finish the week with nothing left on my plate so I could go home and be with my dad. I took my obstetrics exam and did not take the time to thoroughly check my answers: I was too tired, and I hoped that the knowledge I had cultivated before October 11 would stick in my head.

By some miracle, that exam, and virtually every subsequent exam, have been among my best grades in medical school. It’s interesting because I was not able to work nearly as hard as I had in the year prior, but I think what happened was that I was forced to learn how to value self-care and self-awareness over the pursuit of a good grade. When the 11th of the month rolls around, I feel hopeless. And regardless of the proximity to an exam, I take time to honor my Thatha’s memory, whether it’s looking through old photographs or trying to learn about his favorite sport, tennis. It is never easy to mourn, but I think the unique challenges of medical school make this process especially difficult — particularly, trying to work around the demands of providing care for other people, even actors like our standardized patients, so rapidly after a traumatic event or learning about material that felt so triggering. As an example, much of our first trimester curriculum expanded on various topics that could be summarized by “ways in which diabetes wreaks havoc on the body,” whether it’s life-threatening, drug-resistant urinary tract infections in urology or peripheral neuropathy and its complications in surgery. For that reason, I came up with some tips based on my experience these past three months, that I hope you can use whether for yourself or for a friend, if you ever find yourself in the position of mourning in medical school:

1. Reach out to your school: Student affairs has been immensely helpful through this entire process. Even before my grandfather passed, I was able to make arrangements to have my formal engagement ceremony in the presence of my grandfather and family elders in India because student affairs granted me excused absences for the three days of class I would miss. And when my grandfather passed and was no longer going to be physically present at the ceremony, student affairs was supportive of my decision to still go to India and offered me assistance in the days and weeks following my grandfather’s passing.

2. Talk to your peers: Even though medical school is incredibly stressful and everyone is just trying to stay on top of all the new material, people care about you and what you are facing. By far one of the most comforting and affirming experiences was opening my phone to gracious text messages from classmates and peers who were not even necessarily my closest friends. My friends though were great and really did come through for me even when it felt like I was dragging myself through the term.

3. Take time to find your peace: The amount of work we as medical students do to survive academically is not lost on me. But what complicates it even more are feelings of doubt, guilt and sadness. To this day, I struggle with guilt about my decision to stay back and complete my course rather than going to be with my grandmother. Sometimes I wonder if I really could have done something to make a difference. Could something I said have changed the course of my grandfather’s life? And when I reach those moments, I have to take a step back, pause and meditate. Yes, I meditate. But whether you find your peace going for a run, or calling a friend, you should avail yourself of that resource and put a premium on that. I am reminded of advice my mom always gives: “How can you care for others if you won’t even care for yourself?”

4. It’s okay to cry alone in your apartment and want a hug: Basically, it’s okay to grieve in your own way. There is no correct way to feel when you experience a loss. Having compassion for yourself and for what your needs are is important throughout life, but is so critical to beginning to heal. Sometimes, when I’m alone, I can’t help but cry and feel this gaping hole in my heart. I wonder when I will start to feel better, when I’ll ever feel that happiness again. Rationally, I know the day will come, but emotionally it all feels so distant, like a blur galaxies away from the present.

5. Honor your loved ones: Honor your loved ones by living and making progress in the life you do have. I hope that in writing this piece, in continuing to go to school so I can become the doctor my Thatha always envisioned I would be, I am honoring his life, his love and his legacy.

2015 — The first time Thatha met Student Doctor Aishwarya

Author’s note: This article is written in loving memory of KS Chandrasekaran, my maternal grandfather, and one of the greatest souls I will ever know.

Aishwarya is a second year medical student at the Philadelphia College of Osteopathic Medicine. She relishes any opportunity to talk policy, social determinants of health, mental health parity and inclusion topics. Outside of school, Aishwarya enjoys yoga, green tea with lemon and copious amounts of dark chocolate.

Doctor of Policy is a column dedicated to exploring and challenging contemporary health policy issues, especially in the fields of behavioral health, health care access, and inclusion, all from the eyes of a public health girl in a basic sciences world

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